Ambulatory transradial percutaneous coronary intervention: A safe, effective, and cost-saving strategy

Authors

  • Philippe Le Corvoisier MD, PhD,

    Corresponding author
    1. Inserm, Centre d'Investigation Clinique 006, U955 équipe 3, Créteil, France
    2. Université Paris Est, Faculté de Médecine, Créteil, France
    3. AP-HP, Groupe Hospitalier Henri Mondor, Pole Recherche Clinique et Santé Publique, Centre d'Investigation Clinique 006, Créteil, France
    • Hôpital Henri Mondor, Centre d'Investigation Clinique 006, 51 Avenue du Maréchal de Lattre de Tassigny, Créteil, France
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  • Barnabas Gellen MD, PhD,

    1. AP-HP, Groupe Hospitalier Henri Mondor, Département de Cardiologie Interventionnelle, Créteil, France
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  • Pierre-François Lesault MD,

    1. AP-HP, Groupe Hospitalier Henri Mondor, Département de Cardiologie Interventionnelle, Créteil, France
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  • Remy Cohen MD,

    1. Hôpital de Lagny-Marne la Vallée, Service de Cardiologie, Lagny sur Marne, France
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  • Stéphane Champagne MD,

    1. AP-HP, Groupe Hospitalier Henri Mondor, Département de Cardiologie Interventionnelle, Créteil, France
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  • Anne-Marie Duval MD,

    1. AP-HP, Groupe Hospitalier Henri Mondor, Fédération de Cardiologie, Créteil, France
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  • Gilles Montalescot MD, PhD,

    1. AP-HP, Groupe Hospitalier Pitié-Salpétrière, Service de Cardiologie, Paris, France
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  • Simon Elhadad MD,

    1. Hôpital de Lagny-Marne la Vallée, Service de Cardiologie, Lagny sur Marne, France
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  • Olivier Montagne MD,

    1. Inserm, Centre d'Investigation Clinique 006, U955 équipe 3, Créteil, France
    2. Université Paris Est, Faculté de Médecine, Créteil, France
    3. AP-HP, Groupe Hospitalier Henri Mondor, Pole Recherche Clinique et Santé Publique, Centre d'Investigation Clinique 006, Créteil, France
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  • Isabelle Durand-Zaleski MD, PhD,

    1. AP-HP, Groupe Hospitalier Henri Mondor, Service de Santé Publique, Créteil, France
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  • Jean-Luc Dubois-Randé MD, PhD,

    1. Université Paris Est, Faculté de Médecine, Créteil, France
    2. AP-HP, Groupe Hospitalier Henri Mondor, Fédération de Cardiologie, Créteil, France
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  • Emmanuel Teiger MD, PhD

    1. Université Paris Est, Faculté de Médecine, Créteil, France
    2. AP-HP, Groupe Hospitalier Henri Mondor, Département de Cardiologie Interventionnelle, Créteil, France
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  • Conflict of interest: Nothing to report.

Abstract

Objectives: The aim of this prospective, multicenter study was to assess the safety, feasibility, acceptance, and cost of ambulatory transradial percutaneous coronary intervention (PCI) under the conditions of everyday practice. Background: Major advances in PCI techniques have considerably reduced the incidence of post-procedure complications. However, overnight admission still constitutes the standard of care in most interventional cardiology centers. Methods: Eligibility for ambulatory management was assessed in 370 patients with stable angina referred to three high-volume angioplasty centers. On the basis of pre-specified clinical and PCI-linked criteria, 220 patients were selected for ambulatory PCI. Results: The study population included a substantial proportion of patients with complex procedures: 115 (52.3%) patients with multivessel coronary artery disease, 50 (22.7%) patients with multilesion procedures, and 60 (21.5%) bifurcation lesions. After 4-6 hr observation period, 213 of the 220 patients (96.8%) were cleared for discharge. The remaining seven (3.2%) patients were kept overnight for unstable angina (n = 1), atypical chest discomfort (n = 2), puncture site hematoma (n = 1), or non-cardiovascular reasons (n = 3). Within 24 hr after discharge, no patients experienced readmission, stent occlusion, recurrent ischemia, or local complications. Furthermore, 99% of patients were satisfied with ambulatory management and 85% reported no anxiety. The average non-procedural cost was lower for ambulatory PCI than conventional PCI (1,230 ± 98 Euros vs. 2,304 ± 1814 Euros, P < 10−6). Conclusions: Ambulatory PCI in patients with stable coronary artery disease is safe, effective, and well accepted by the patients. It may both significantly reduce costs and optimize hospital resource utilization. © 2012 Wiley Periodicals, Inc.

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